title: Validation of the new Graded Prognostic Assessment scale for brain metastases: a multicenter prospective study.
abstract: BACKGROUND
  Prognostic indexes are useful to guide tailored treatment strategies for cancer patients with brain metastasis (BM). We evaluated the new Graded Prognostic Assessment (GPA) scale in a prospective validation study to compare it with two published prognostic indexes.
  
  
  METHODS
  A total of 285 newly diagnosed BM (n = 85 with synchronous BM) patients, accrued prospectively between 2000 and 2009, were included in this analysis. Mean age was 62 ± 12.0 years. The median KPS and number of BM was 70 (range, 20-100) and 3 (range, 1-50), respectively. The majority of primary tumours were lung (53%), or breast (17%) cancers. Treatment was administered to 255 (89.5%) patients. Only a minority of patients could be classified prospectively in a favourable prognostic class: GPA 3.5-4: 3.9%; recursive partitioning analysis (RPA) 1, 8.4% and Basic Score for BM (BSBM) 3, 9.1%. Mean follow-up (FU) time was 5.2 ± 4.7 months.
  
  
  RESULTS
  During the period of FU, 225 (78.9%) patients died. The 6 months- and 1 year-OS was 36.9% and 17.6%, respectively. On multivariate analysis, performance status (P < 0.001), BSBM (P < 0.001), Center (P = 0.007), RPA (P = 0.02) and GPA (P = 0.03) were statistically significant for OS. The survival prediction performances' of all indexes were identical. Noteworthy, the significant OS difference observed within 3 months of diagnosis between the BSBM, RPA and GPA classes/groups was not observed after this cut-off time point. Harrell's concordance indexes C were 0.58, 0.61 and 0.58 for the GPA, BSBM and RPA, respectively.
  
  
  CONCLUSIONS
  Our data suggest that the new GPA index is a valid prognostic index. In this prospective study, the prediction performance was as good as the BSBM or RPA systems. These published indexes may however have limited long term prognostication capability.
authors.affiliation: Department of Radiation Oncology and Clinical Epidemiology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Salvador
authors.initials: S
authors.lastname: Villà
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.forename: Cristina
authors.initials: C
authors.lastname: Moretones
authors.forename: Anabel
authors.initials: A
authors.lastname: Mañes
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: Josep
authors.initials: J
authors.lastname: Jové
authors.forename: Paloma
authors.initials: P
authors.lastname: Puyalto
authors.forename: Patricia
authors.initials: P
authors.lastname: Cuadras
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruna
authors.forename: Eugènia
authors.initials: E
authors.lastname: Verger
authors.forename: Carme
authors.initials: C
authors.lastname: Balañà
authors.forename: Francesc
authors.initials: F
authors.lastname: Graus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D006305:Health Status Indicators; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020266:Radiotherapy, Conformal; D016019:Survival Analysis; D055815:Young Adult